title: ["Factitious disorder and skin picking: Clinical approach". A case report].
abstract: OBJECTIVE
  The number of patients requiring primary and secondary care for factitious disorder unexplained by any known medical condition is high. We report a case illustrating the clinical and psychopathological features of factitious disorder. The treatment difficulties encountered in the association of this disorder with dermatillomania are discussed.
  
  
  METHODS
  The patient was a 22-year old girl with abrasions on the face and forearms with ingested epidermal layer of the skin. She also had multiple somatic complaints, the authenticity of which was difficult to confirm. The diagnosis of comorbid factitious disorder with dermatillomania was retained. In view of reducing self-harm acts, we prescribed a mood stabilizer associated with an anxiolytic for 6 months. The self-harming acts have regressed, while the hypochondriacal complaints remain with a tendency of overstatement.
  
  
  CONCLUSIONS
  Factitious disorder (FD) is a mental disorder occurring in patients acting intentionally similar to a physically or mentally sick person with no apparent benefits. The reported cases often show FD comorbidity with other psychiatric disorders such as substance abuse, somatoform disorders, dysthymia, borderline personality disorder and sexual disorders. Comorbidity of factitious disorder with neurotic excoriation is exceptional, and rarely described in the literature. Pathological skin picking (PSP) is a disabling disorder characterized by repetitive skin picking, which causes tissue damage. It was estimated to affect 2% of the population. PSP is currently listed as an impulse control disorder not otherwise specified, it is associated with a high rate of psychiatric comorbidity like borderline personality disorder.
  
  
  CONCLUSIONS
  The comorbidity of factitious disorder and dermatillomania makes diagnosis very difficult. The limit between the two disorders is sometimes unclear.
authors.affiliation: Service de psychiatrie, CHU Hassan II, Fès, Maroc; Université Sidi Mohamed Ben Abdellah, faculté de médecine et de pharmacie de Fès, Fès, Maroc. Electronic address: hayathlal@yahoo.fr.
authors.forename: H
authors.initials: H
authors.lastname: Hlal
authors.affiliation: Service de psychiatrie, CHU Hassan II, Fès, Maroc; Université Sidi Mohamed Ben Abdellah, faculté de médecine et de pharmacie de Fès, Fès, Maroc.
authors.forename: M
authors.initials: M
authors.lastname: Barrimi
authors.affiliation: Service de psychiatrie, CHU Hassan II, Fès, Maroc; Université Sidi Mohamed Ben Abdellah, faculté de médecine et de pharmacie de Fès, Fès, Maroc.
authors.forename: N
authors.initials: N
authors.lastname: Kettani
authors.affiliation: Service de psychiatrie, CHU Hassan II, Fès, Maroc; Université Sidi Mohamed Ben Abdellah, faculté de médecine et de pharmacie de Fès, Fès, Maroc.
authors.forename: I
authors.initials: I
authors.lastname: Rammouz
authors.affiliation: Service de psychiatrie, CHU Hassan II, Fès, Maroc; Université Sidi Mohamed Ben Abdellah, faculté de médecine et de pharmacie de Fès, Fès, Maroc.
authors.forename: R
authors.initials: R
authors.lastname: Aalouane
mesh_terms: D000525:Alprazolam / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D015897:Comorbidity; D003937:Diagnosis, Differential; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D005162:Factitious Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D005260:Female; D006801:Humans; D006998:Hypochondriasis / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D016728:Self-Injurious Behavior / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D012867:Skin / Q000293:injuries*; D013001:Somatoform Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D014635:Valproic Acid / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014635:Valproic Acid; D000525:Alprazolam
keywords: Comorbidity; Comorbidité; Dermatillomanie; Factitious disorder; Psychopathologie; Psychopathology; Skin picking; Trouble factice